重症肺炎患儿病原学调查及病原菌耐药性分析

Survey of etiology of children with severe pneumonia and drug resistance of pathogens

目的了解南京市儿童医院重症肺炎患儿病原学分布及主要病原菌耐药性。方法选取2016年01月-12月重症肺炎患儿198例作为研究对象,收集患儿鼻咽分泌物行病原菌培养及药敏鉴定,并采用实时荧光定量PCR技术(qPCR)对其他病原进行检测。结果 198例患儿中有141例检出至少一种病原体,总检出阳性率为71.2%;共检出病原菌115株,占46.37%,其中革兰阴性菌85株,占34.27%,革兰阳性菌31株,占12.50%,病原菌中鲍氏不动杆菌检出最多,为21株占8.47%;共检出病毒86株,占34.68%,鼻病毒检出最多,为21株占8.47%;非典型病原体46株占18.55%,肺炎支原体31株占12.5%,为检出最多的病原体;药物敏感试验提示革兰阴性菌对常见的青霉素类及一、二代头孢均有很高的耐药率,对于三、四代头孢菌素以及碳青霉烯类等药物也有一定程度的耐药。结论南京地区儿童重症肺炎病原仍以病原菌为主,革兰阴性菌占优势,主要病原菌对多种抗菌药物耐药。

OBJECTIVE To understand the etiological distribution of children with severe pneumonia in Nanjing Children Hospital and analyze the drug resistance of major species of pathogens.METHODS A total of 198 children with severe pneumonia who were treated from Jan 2016 to Dec 2016 were recruited as the study objects,the nasopharyngeal secretion specimens were collected for bacterial culture,the drug susceptibility testing was performed,and other species of pathogens were detected by means of real-time fluorescent quantitative PCR technique.RESULTS At least one species of pathogen was detected in 141 of 198 children,with the total positive rate of detection 71.2%.Totally 115（46.37%）strains of pathogens were isolated,of which 85（34.27%）were gram-negative bacteria,31（12.5%）were gram-positive bacteria;21 strains of Acinetobacter baumannii were isolated,accounting for 8.47%.Totally 86（34.68%）strains of viruses were isolated,of which 21（8.47%）were rhinovirus,46（18.55%）were atypical pathogens,and 31（12.5%）were Mycoplasma pneumoniae.The drug susceptibility testing indicated that the gram-negative bacteria were highly resistant to the commonly used penicillins,first and second cephalosporins,and they showed certain drug resistance to the third,fourth cephalosporins as well as carbapenems.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the severe pneumonia in the children in Nanjing,and the major species of pathogens are resistant to a variety of antibiotics.